Causes of Total Knee Revision in Emerging Economies: Is It Different from the Western World?

Abstract

There is limited information in English literature regarding the cause of revision total knee arthroplasty (TKA) in emerging economies. The purpose of this study is to report a detailed analysis of the TKA failure mechanisms from a referral hospital in India and to determine whether the failure mechanisms of primary TKA are different from that of the western world. A total of 53 revision TKAs performed at our institution over the past 5 years were identified. The revision TKA group was divided into subgroups according to the cause of failure, including infection, aseptic loosening, periprosthetic fracture, instability, extensor mechanism failure, and other causes. All revision TKA patients were subdivided into early (less than 2 years from primary) and late (more than 2 years from primary) failure groups depending upon the time interval between primary TKA and revision procedure. The overall common failure mechanisms were infection (73.58%), aseptic loosening (13.2%), and periprosthetic fracture (5.6%). Infection was the most common failure mechanism for early revision (< 2 years from primary) and aseptic loosening was the most common reason for late revision. Our study shows a pattern similar to the earliest trends of revision TKA in western literature reporting infection as the major cause for revision. The level of evidence for the study is Level 3.

Keywords

revision total knee arthroplasty - failure mechanisms - emerging economies

• References

• 1 Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am 2004; 86-A (9) 1909-1916
• 2 Mullaji AB, Sharma AK, Marawar SV, Kohli AF. Tibial torsion in non-arthritic Indian adults: a computer tomography study of 100 limbs. Indian J Orthop 2008; 42 (3) 309-313
• 3 Parvizi J, Zmistowski B, Berbari EF , et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
• 4 Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989; (248) 9-12
• 5 O'Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Osteolysis associated with a cemented modular posterior-cruciate-substituting total knee design : five to eight-year follow-up. J Bone Joint Surg Am 2002; 84-A (8) 1362-1371
• 6 Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991; 73 (5) 709-714
• 7 Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin Orthop Relat Res 2001; (392) 315-318
• 8 Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res 2002; (404) 7-13
• 9 Vessely MB, Whaley AL, Harmsen WS, Schleck CD, Berry DJ. The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res 2006; 452 (452) 28-34
• 10 Bozic KJ, Durbhakula S, Berry DJ , et al. Differences in patient and procedure characteristics and hospital resource use in primary and revision total joint arthroplasty: a multicenter study. J Arthroplasty 2005; 20 (7) (Suppl. 03) 17-25
• 11 Hossain F, Patel S, Haddad FS. Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res 2010; 468 (5) 1221-1228
• 12 Dalury DF, Pomeroy DL, Gorab RS, Adams MJ. Why are total knee arthroplasties being revised?. J Arthroplasty 2013; 28 (8, Suppl) 120-121
• 13 Kasahara Y, Majima T, Kimura S, Nishiike O, Uchida J. What are the causes of revision total knee arthroplasty in Japan?. Clin Orthop Relat Res 2013; 471 (5) 1533-1538
• 14 Schroer WC, Berend KR, Lombardi AV , et al. Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplasty 2013; 28 (8, Suppl) 116-119
• 15 Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today—has anything changed after 10 years?. J Arthroplasty 2014; 29 (9) 1774-1778
• 16 The World Bank. Health expenditure, total (% of GDP). Available at: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS . Accessed January 18, 2015
• 17 Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am 1999; 81 (10) 1434-1445
• 18 Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 2001; (392) 15-23
• 19 Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total knee arthroplasty. J Bone Joint Surg Br 2004; 86 (5) 688-691
• 20 Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008; 466 (7) 1710-1715
• 21 Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res 2009; 467 (6) 1577-1581
• 22 Marchant Jr MH, Viens NA, Cook C, Vail TP, Bolognesi MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am 2009; 91 (7) 1621-1629
• 23 Lehman CR, Ries MD, Paiement GD, Davidson AB. Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use. J Arthroplasty 2001; 16 (3) 330-335
• 24 Berbari EF, Hanssen AD, Duffy MC , et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998; 27 (5) 1247-1254
• 25 Jeys LM, Grimer RJ, Carter SR, Tillman RM. Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am 2005; 87 (4) 842-849
• 26 Drancourt M, Argenson JN, Tissot Dupont H, Aubaniac JM, Raoult D. Psoriasis is a risk factor for hip-prosthesis infection. Eur J Epidemiol 1997; 13 (2) 205-207
• 27 Hebert CK, Williams RE, Levy RS, Barrack RL. Cost of treating an infected total knee replacement. Clin Orthop Relat Res 1996; (331) 140-145
• 28 Mahomed NN, Barrett J, Katz JN, Baron JA, Wright J, Losina E. Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg Am 2005; 87 (6) 1222-1228
• 29 Nakama GY, Peccin MS, Almeida GJ, Lira Neto OdeA, Queiroz AA, Navarro RD. Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases. Cochrane Database Syst Rev 2012; 10 (CD006193): CD006193